Ongoing controversy at South African National Blood Service

The controversy in South Africa that began over a racial profiling policy that accepted blood from black donors then destroyed it is multi-faceted. See TraQ's international news section.

After the policy was exposed, the South African National Blood Service (SANBS) said that its risk management program was flawed because it relied heavily on race as a risk factor and that the risk model would be revised. SANBS also apologized to President Mbeki whose blood was discarded.

Subsequently, the organization was accused of sexual discrimination because it classifies donors who admitted to man-to-man sex as high risk, despite the statistics that in SA heterosexual women aged 18 to 24 are at high risk for HIV infections.

The latest issue is that SANBS has had to defend its policy of selling donated blood, explaining that they do not charge for blood per se, but rather for services rendered in the procurement, collection, testing, processing,and issuing of blood.

Despite the controversies, it is likely that SANBS will be chosen as South Africa's new national blood transfusion service.

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Comprehensive review of Google Scholar

Must-read review of Google Scholar is found at Peter's Digital Reference Shelf -
If you were thinking of using Scholar to find papers, this comprehensive critique tells all you need to know.

What's New on TraQ

Limitations of Google Scholar

Limitations of Google Scholar (still in beta testing) are beginning to appear. For example:

• Google Scholar documentation (Search Engine Watch)
• Google Scholarly (Free Pint)

Main messages are that documentation is lacking on what's in the database (not always "scholarly") and that students may bypass established databases containing peer reviewed papers.

What's New on TraQ

Google Scholar

Google has launched Google Scholar, a new search engine for researchers aimed at increasing public access to academic material such as published papers, theses, technical reports, and books.

I particularly like the "cited by" feature, which provides links to other papers that have cited the original (at least the ones in Scholar's database). This type of citation analysis is an innovative variation of PubMed's invaluable "related articles" feature.

Sample Searches. Got to http://scholar.google.com and enter:

Ex. 1. Heddle transfusion

Ex. 2. predictive value transfusion

Ex. 3. root cause analysis transfusion

For more information see

• Google Scholar FAQs
• Biomed Central welcomes launch of Google Scholar
• Search Engine Watch's review
• Google Scholar is born

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TraQ has been following the UK's response to the EU Blood Directive, which extends regulation of the blood system from blood suppliers to hospital blood banks. This is similar to the situation in Canada, in which CSA Z902-04 Standards will eventually become government regulations that impact hospital transfusion services.

• See CSA Standards Z902-04:Implications and Issues

The UK Dept. of Health has now called for Public consultation on The Blood Safety and Quality Regulations 2005

Although the EU Directive does not specifically require accreditation, licensing or inspection of hospital blood banks, it does make them subject to several articles, including those concerning

• PersonnelQuality Management
• Quality system and DocumentationHaemovigilance - Traceability & Notification of serious adverse events and reactions
• Quality and Safety of Blood and Blood Components - Storage, transport and distribution conditions
• Data protection and confidentiality

In Canada, we do not yet know which Z902-04 clauses will become government regulations but it will be interesting see how closely they mirror the EU Directive approach. For more information, see TraQ's backgrounder on the EU Directive

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International Woman in Transfusion Award

In 2004 three of the major transfusion medicine organizations in the world were led by women. To honour the occasion the organizations (AABB, BBTS, and ISBT) created the International Woman in Transfusion Award

It's not surprising that a year would come when women headed several major TM organizations as women are incredibly active in transfusion medicine. I encourage everyone to consider nominating one of your colleages for this new award.

As to the 3 presidents - I'm tempted to say "3 amigos"....

- see brief profiles on

• AABB President Kathleen Sazama, MD, JD (Source: Society for the Advancement of Blood Management )


• BBTS President Judith Chapman, FIBMS, MBA
  (Source: UK Blood Stocks Management Scheme)


• ISBT President Francine Décary, MD, PhD, MBA(Source: University of Sherbrooke)

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Transfusion medicine forums and mailing lists

One of the things people tell me about the Internet is how difficult it is to keep up with all the resources that are available. This applies to a new resource just added to TraQ's Resource Library:

• Transfusion medicine forums & mailing lists

On the plus side, it's great to have multiple sources of information and places to ask questions. On the downside, searching in multiple places takes time and any information found must be carefully evaluated for validity and relevance.

A rule of thumb is that moderated lists have higher quality information, which would place the CBBS e-network Forum moderated by Ira Shulman, MD at the top of the pecking order in the TraQ list. Indeed, the entire CBBS website maintained by webmasters J. Lawrence Naiman, MD and Eileen A. Selogie, MT (ASCP) SBB) is a class act!

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Québec eliminates upper age limit for donors

You know the population is aging when they want your blood until you drop! On 31 October 2004 Héma-Québec (the blood supplier in the Canadian province of Québec) will eliminate the upper age limit for donors.

There are several safety criteria involving approval from the donor's physician but it seems that so long as "the bod is warm" and you are in good health, you can now be a life-long blood donor.

A few statisics to ponder:

• According to Statistics Canada, in 2004 ~5.6 million (17.7%) of Canada's total population of 32 million are over 60.
• In Canada only 3.7 % of eligible people are blood donors. By comparison, 6% of Britains donate blood; in the USA, Ireland and Japan, the figure is ~5%, while in Taiwan, it's 7.5 % - nearly double the total in Canada.
  

With demographics like these we definitely need our oldsters - tried and true donors with multiple donations to their credit, to continue to give, and give, and give.....

Resources:

• CBS press release (June 2004): Less than four out of every 100 eligible Canadians donate blood each year
• Statistics Canada: Population by age & sex

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vCJD found in frequent donor in France

Now that vCJD has been found in a frequent blood donor in France, it will be interesting to see if French officials follow the lead of the UK who notified 1000s of donors in September that they may be at increased risk of carrying vCJD. The donor's blood was transfused to 10 recipients but was also used to make unspecified "medicines" - enough for several 1000 people.

See TraQ's vCJD clearinghouse

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Readers beware

Two articles added today to TraQ's International News section present different "takes" on the same session held at a major transfusion medicine conference in Australia.The first article from The Age is titled Safety call on hospital blood use and begins, "Doctors yesterday called for identity wristbands for all blood transfusion patients to protect against the potentially fatal consequences of receiving the wrong blood type." The second article from the Sydney Morning Herald (Hospitals ignoring blood label rules) begins, "Blood transfusion protocols are being shunned in some hospitals, posing a potentially fatal threat to patient health, a conference has heard."

From what was reported in the articles, Dr. Lorna Wilkinson discussed the UK SHOT scheme. Chris Hogan (an Australian hematologist) and Neil Boyce (of the Australian Red Cross Blood Service) spoke on efforts in Australia to improve processes and develop a reporting scheme such as SHOT. All speakers noted the rare but potentially fatal consequences of identification errors.

From my perspective, The Age news report presents a more balanced view than the Sydney Morning Herald report does. The latter's headline (Hospitals ignoring blood label rules) sets the tone for the article and is misleading.

* Joint Annual Meeting of the Australia and New Zealand Society of Blood Transfusion, Hematology Society of Australia, and the Australian Society of Thrombosis and Haemostasis (17-24 October, Melbourne)

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CSTM standards

Canadians comprise an outward looking country and tend to be international in scope. In practice this translates into looking at standards and guidelines from other countries when developing our own, e.g., AABB standards, ANZSBT and BCSH guidelines

Assuming that those in other countries may take a similar approach, I would like to recommend the new Standards of the Canadian Society for Transfusion Medicine (CSTM):

Standards for Hospital Transfusion Services, v. 1

CSTM Standards comply with Blood and Blood Components (CSA Z902-04), which encompass standards for both hospitals and blood centres.

Written in user friendly language, the CSTM Standards eliminate the "regulese" often found in regulatory documents. Whenever possible, they present the standards in sequences that correlate to how transfusion professionals practice, for example, the work flow within hospital transfusion services.

Those outside of Canada may find them useful for how the CSTM has approached impending government regulation of hospital transfusion services, a situation analogous to the implications of the EU Blood Directive for the UK and other European transfusion services.

Disclosure: I am the webmaster of the CSTM.

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Canada's TSO mailing list

Having just posted several messages to "transfusion" - a bilingual mailing list for Canada's Transfusion Safety Officers (TSOs) - reminds me to promote this valuable resource to those working in Canada's blood system (technologists, nurses, physicians, etc.)

You do not have to be a TSO to join but you do have to work in Canada (translation costs preclude opening the list to worldwide subscribers).

To join "transfusion", please read the TSO FAQ, then contact info@transfusionsafety.ca with your details.

Disclosure: I am also the TSO webmaster and list manager.

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TraQ has a blog!

TraQ has a blog - a web log named On TraQ for transfusion medicine professionals about everything related to transfusion. A blog is an online journal using software that makes it easy to update throughout the day.

The blog will allow me to expand on some of the resources posted on TraQ and will include recommendations and views that are solely my personal responsibility, not that of TraQ.

Let me know if there is anything you would like to see added here.

What's new on TraQ

Cheers, Pat (TraQ web coordinator)

Editorial with evidence-based approach

Thought you should see the format of On TraQ from the get-go. The style will be informal and the content will reflect whatever's on my mind.

If you are interested evidence-based medicine and want a transfusion-related example of how to approach analysing papers critically, this editorial is a keeper:
Do transfusions get to the heart of the matter? Hébert PC, Fergusson DA. JAMA 2004;292:1610-2.

The editorial is worth it for what it shows about how to evaluate the literature. Even if you don't normally have access to JAMA, make the effort and find out how you can get copies of journal articles. Ask your medical director or hospital librarian. It will be a good exercise in professional development/continuing education.

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